title: Prevention of sternal wound infection in pediatric cardiac surgery: a protocolized approach.
abstract: BACKGROUND
  Sternal wound infections (SWIs) are a costly complication for children after cardiac surgery, increasing morbidity, mortality, and financial cost. There are no pediatric guidelines to reduce the incidence of SWI in this vulnerable population.
  
  
  METHODS
  A quality improvement, multidisciplinary team was formed, and a protocol to prevent SWI was developed. A prospective review of patients who underwent pediatric cardiac surgery was conducted over a two-year period to follow adherence to the protocol and incidence of SWI. The Centers for Disease Control definitions for surgical site infections were used to determine the depth and presence of infection.
  
  
  RESULTS
  Three hundred and eight children <18 years of age had sternotomies during the study period. There was a reduction in all SWI between the first and second years of the study (odds ratio [OR] = 0.35; confidence interval [CI] 95% 0.12-1.01; P = .059). Delayed sternal closure (DSC) was associated with increased risk of SWI (OR = 5.4; CI 95% 2.13-14.9; P ≤ .001). Institution of a protocol in patients with DSC was associated with decreased infections during the second year (first year: n = 7 (14%), second year: n = 2 (4%), P = .14).
  
  
  CONCLUSIONS
  Institution of a protocol was associated with a decreased number of infections in children. A multicenter study of a bundled protocol approach to SWI prevention is needed. Children with DSC had a significantly higher risk of developing a wound infection. Initiating strategies to reduce SWI with a focus on children with DSC may result in improved overall infection rates.
authors.affiliation: Division of Critical Care, Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Cathy S
authors.initials: CS
authors.lastname: Woodward
authors.forename: Minnette
authors.initials: M
authors.lastname: Son
authors.forename: Richard
authors.initials: R
authors.lastname: Taylor
authors.forename: S Adil
authors.initials: SA
authors.lastname: Husain
keywords: pediatric; sternal wound infection; sternum; surgical site infection